title: Professional boundary work in the face of change to generalist working in community nursing in Scotland.
abstract: OBJECTIVE
  The present study explored how community nurses and managers constituted changes towards generalist working.
  
  
  BACKGROUND
  Following international trends moving from acute care towards community care, changes within community nursing in the United Kingdom have been subject to debate in recent years. Sociological insights into 'boundary work' in professional disciplines are informative for understandings about proposed new roles in community nursing. Recently, radical changes to the role of the community nurse from specialist disciplines to a generalist community health nurse model were proposed in Scotland and tested in four health boards.
  
  
  METHODS
  Focus group discussions were held with 27 community nurses and semi-structured interviews with three managers during January-March 2009 in a purposive sample from one health board. Discussions were audio-recorded and transcribed verbatim. Initial thematic analysis was used to highlight key themes from the data and later a discursive analysis focused on the rhetorical strategies used by participants.
  
  
  RESULTS
  Four key themes were identified along with the rhetorical devices associated with these including: the undermining of the generalist model through the 'jack of all trades, master of none' metaphor through associations of loss of specialisms; how the re-establishment of specialist discipline boundaries occurred; how current roles were validated and how managers and nurses accounted for future changes to the profession.
  
  
  CONCLUSIONS
  The qualitative study explored here has implications for discussions about future role change debates within community nursing as well as the specialist-generalist debate internationally. Managers and policy-makers involved in organizational changes are required to give greater credence to the perceived professional status of community nursing.
authors.affiliation: School of Nursing, Midwifery & Social Care, Edinburgh Napier University, UK. c.gray2@napier.ac.uk
authors.forename: Carol
authors.initials: C
authors.lastname: Gray
authors.forename: Rhona
authors.initials: R
authors.lastname: Hogg
authors.forename: Catriona
authors.initials: C
authors.lastname: Kennedy
mesh_terms: D001291:Attitude of Health Personnel; D002648:Child; D002983:Clinical Competence / Q000592:standards; D003152:Community Health Nursing / Q000458:organization & administration* / Q000639:trends; D017144:Focus Groups; D018166:Health Care Reform / Q000458:organization & administration; D006801:Humans; D008875:Middle Aged; D024802:Nurse's Role; D009740:Nursing Staff / Q000458:organization & administration; D019982:Organizational Case Studies; D009936:Organizational Innovation; D036301:Qualitative Research; D012606:Scotland; D013038:Specialization / Q000639:trends*; D013222:State Medicine / Q000458:organization & administration / Q000639:trends; D011795:Surveys and Questionnaires